Community Pharmacists Demand CMS Take Enforcement Action Against PBMs

As news surfaced on February 27 that Congress is punting long-debated pharmacy benefit manager reforms, the community pharmacy lobby demanded CMS immediately take enforcement action against improper PBM practices that the lobby says could cause nearly a third of independent pharmacies to shutter this year. […]

Jonathan Swichar, partner and chair of Duane Morris’ Pharmacy Litigation Group, alleged denying reimbursement and reimbursing at below cost is a tactic used by PBMs to hurt independent pharmacies.

“It’s one of the many initiatives employed by pharmacy benefit managers of the past 10 years to eliminate the competition independent pharmacies pose to their own affiliate pharmacies,” he said. […]

[Swichar explained the last few years have been difficult for independent pharmacies because of increased demand for vaccines, especially becoming overwhelmed with individuals needing COVID-19 vaccines. Pharmacies sometimes were the only source for those vaccinations.

To meet demand, the independent pharmacies needed to hire additional staff members, adding a costly burden to pharmacies that are already sensitive to revenue.

“Unfortunately, while independent pharmacies have very much been asked to step up to the plate, and often act in a way that traditionally would have been the responsibility of a doctor’s office in terms of administering vaccines, one of the areas where pharmacy benefit managers have been most difficult, with regard to reimbursement, is the vaccinations that pharmacies have administered over the past few years,” he said. […]

Read the full article on Inside Health Policy. (Registration required for free access.)

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